European Urology Today
EUT Congress News
TFhi risrdt EEdd iittiio onn
33rd 32nd Annual Annual Congress Congress of of the the European European Association Association of of Urology Urology
Monday, Saturday,19 25March March2018 2017
Copenhagen, 16-20 March 2018 London, 24-28 2017
Benefits of upfront PET-CT use still unclear Plenary Session 3 evaluates new diagnostics for oligometastatic PCa By Loek Keizer
leaving Mottet to give the audience at the eURO Auditorium the perspective of the most current EAU Guidelines. The Guidelines considers PET PSMA ‘of interest’, despite the lack of evidence of effectiveness for upfront staging. Targeting the metastases, as De Meerleer advocated for, is considered ‘experimental’, and interesting to evaluate.
“Nobody knows yet if using PET-CT upfront is beneficial, or if picking up small traces of the disease can lead to patient improvement in survival and outcomes. We know from some series that there might be a place for such imaging techniques, but certainly not for all patients. It can be a waste of money and time,” Prof. Alberto Briganti (IT) cautioned during Plenary Session 3. The third day of EAU18 started with a well-attended Plenary Session on prostate cancer. The session included several case-based debates, an overview of the most important PCa-related posters and the ESMO lecture. The main session was preceded by a short “Game-changing session”, which featured an update on immunotherapy in renal cell and bladder cancer, and a talk on the new standard of care for hormone-sensitive PCa. Case-based debate on PET-CT The majority of Plenary Session 3 was dedicated to a multidisciplinary case-based debate on PET-CTdetected oligometastatic disease, moderated by
The case-based debate on PET-CT-detected oligometastatic disease is moderated by Prof. Briganti (left).
Briganti. It featured contributions from Prof. Silke Gillessen Sommer (CH) from the perspective of an oncologist, Prof. Steven Joniau (BE) as a urologist, Prof. Gert De Meerleer (BE) as a radiation therapist and finally Prof. Nicolas Mottet (FR) for the EAU Guidelines perspective.
classified as cN0, M0 through conventional imaging, but where the use of a PSMA PET-CT revealed a spread to a lymph node in the pre-sacral area and two bone lesions, both smaller than 1cm. This raised the patient’s status to cN1 and cM1.
The case as presented to the panel by Briganti concerned a 61-year-old patient who was
Profs. Gillessen Sommer, Joniau and De Meerleer argued treatment options from their perspective,
“We saw a nice multidisciplinary discussion, which allowed the audience to see possible treatment options from different perspectives,” Briganti summarised. “Of course we always need evidence first, but there is certainly a role for expert opinion. We are waiting for strong evidence yet to come.” On the timeframe of possible strong evidence for the advantage of upfront use of PET-CT, he said: “We might never even see it. We are currently using PSMA, but in a few years or even months, we might have a better tracer. It’s a constantly evolving field.” See related story on Page 2... Better PCa detection...
LUTS: Individualised care offers improve QoL Plenary Session 4 examines tailored LUTS management By Erika de Groot Urodynamics, the link between LUTS and progressive neurogenic disease, and polypharmacy were some of the topics deliberated during the well-attended Plenary Session 4 “Contemporary storage Lower Urinary Tract Symptoms (LUTS) management”, which was chaired by Prof. F.C. Fiona Burkhard (CH) and Prof. Chris Chapple GB). Urodynamics “In neurology, there are two main goals: to protect the upper urinary tract and to improve the patients’ quality of life,” stated Prof. Dr. Thomas Kessler (CH). In his lecture “Lower Urinary Tract Symptoms (LUTS) and stable neurogenic disease”, he defined Urodynamics as a tool to assess the function of the lower urinary tract
and to secure the upper urinary tract. Kessler said, “Solving a patient’s symptoms does not also mean also saving the upper urinary tract.” According to Kessler, neurourology is a balancing act. “You have to individualise the management of your patients. Can the patient walk without assistance or is he in a wheelchair? But even then, the latter could have a very active lifestyle. Customised treatment is key; one size does not fit all.” Progressive neurogenic disease “LUTS change as the patient’s conditions evolve,” said Dr. Xavier Gamé (FR) in his lecture “LUTS and progressive neurogenic disease”. Gamé added that adapted management to different symptoms are available. He stated that follow-up is required to
assess LUTS changes and to screen complications in MS patients. Polypharmacy According to Dr. Adrian Wagg (CA), there is little evidence on the link between polypharmacy and overactive bladder (OAB), but more for undifferentiated incontinence. “Polypharmacy makes urinary incontinence more likely,” said Wagg. In his lecture “Age, polypharmacy and OAB”, he stated that when OAB drugs and other antimuscarinics are combined, these contribute to an overall anticholinergic burden. He said that this should be reduced where possible. Additionally, Wagg said that a formal, contextual medication review may help.
Prof. Kessler makes a point on LUTS management
eUROGEN: Improving lives for patients with rare diseases European Reference Network is top performing in EU By Jen Tidman The European Reference Network (ERN) eUROGEN is already the most proactive of the 24 ERNs approved and funded by the European Commission (EC), announced Mrs. Michelle Battye (GB) in a specialty session held yesterday. The ERN unites 29 European healthcare providers in 11 EU member states in order to improve diagnoses and create more equitable access to high-quality treatment and care for patients with rare uro-rectogenital diseases as well as complex conditions needing highly specialised surgery. “This is a completely innovative step change in healthcare. It is not a project; it’s a new form of collaboration that Monday, 19 March 2018
will continue,” said Battye. Thirty million Europeans are affected by 6,000-8,000 rare diseases (‘rare’ being defined as fewer than 1:2,000 people) with many requiring surgical correction, some during the neonatal period or in childhood. Rare disease patients may need transitional or even life-long care provided by expert multidisciplinary teams (MDTs) in areas such as surgery, physiotherapy and psychotherapy. When these patients cannot be adequately treated in their own country their case can be referred to an ERN to be dealt with using a new IT platform, the Clinical Patient Management System (CPMS). Continued on Page 2... eUROGEN: Improving lives... EUT Congress News
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